Recognition Order Form

Use this form to order leaves for the Donor Recognition Sculptures located at Whatcom Hospice House. Donations may be directed either to Hospice House or to the Hospice In-Home Program.
 

INFORMATION WILL BE TRANSMITTED SECURELY
(*= Required Field)

Donor Name(s)*
Phone w/Area Code*
E-Mail*


Exact Text You Desire on Element*:
We will contact you if this text will not work because of space limitations or other constraints.

Choose Sculpture:
 Please recognize my gift on the WALL sculpture.

Choose Level: $5000  $2500 $1000


Please recognize my gift on the GATE Sculpture.

Choose Color: Bronze, $500  Silver, $500
 


How will you be paying?
I will pay online by credit card.
I would like to pay in installments. Please contact me.
I have mailed a check to Whatcom Hospice Foundation.

Address:  Whatcom Hospice Foundation
               2901 Squalicum Parkway
               Bellingham, WA 98225